Our patients’ stories: overcoming breast asymmetry

High school can be hard enough on a girl’s self esteem. But for Kate*, typical rites of passage — like shopping for a prom dress — were impossible.

After trying on dress after dress that didn’t fit, Kate ultimately settled on something in black, with draped fabric to strategically cover her chest. Alterations made the gown wearable, but Kate still worried about whether her date would notice something that had begun to seem increasingly unusual to her about her body.

Kate suffered from severely asymmetrical, or lopsided, breasts. As she moved through puberty, her right breast grew beyond a D cup size, while her left breast never developed more than an A/B cup. It’s a condition that’s common and often overlooked, and extreme cases like Kate’s can cause young girls great distress, research has shown.

By 13, Kate noticed that her breasts looked different from those of her friends and sisters. “I kept hoping the problem would fix itself,” she recalls. “But it kept getting worse.”

Like many teens with breast conditions, Kate didn’t think there was anything that could be done to help her, so she adjusted as best she could. She and her mom, Susan, describe the teen as a reserved, well-liked girl who enjoyed being a part of many school activities and hoped to become a teacher after college. Kate did not let her asymmetry stop her from playing sports, enjoying the beach in the summer and trips to the mall with friends. She managed the problem by stuffing the smaller breast and wearing multiple bras, one that fit each side. “It was always a burden but I did my best to hide it,” she recalls.

Years later, a routine visit to her gynecologist to address persistent rashes and acne around her breasts started Kate on a process that she says changed her life. The doctor referred Kate to a nearby plastic surgeon, who in turn sent her to Boston Children’s Hospital’s Adolescent Breast Center, the first specialized center of its kind in the country.

At age 20, Kate made an appointment to see Brian Labow, MD, director of the adolescent breast clinic, who immediately made her feel at ease. He helped Kate understand that, while some difference between breasts is normal, her asymmetry was one of the worst cases he had ever seen.

The treatment plan they ultimately decided on was for Kate to have several surgeries: The first to reduce the size of the larger breast and a second to put an implant into the smaller breast. A third touch-up procedure finished the process.

At first, Kate wasn’t sure if she could afford the surgeries. But Labow lobbied for her claims to be covered, she says, and credits this effort with ultimately ensuring that her health plan paid for the operations.

As Kate’s case illustrates, the problem was starting to have physical as well as emotional implications. “I’m not a superficial person. It needed to be done,” she says.

In fact, Susan, Kate’s mom, wonders if they should have waited as long as they did. “If I’d had known this was an option, high school could have better for her,” Susan says.

But she says her daughter’s resolve and confidence as a college student may have made her a better candidate for surgery. She chuckles remembering how Labow and his staff had to take photographs and draw on Kate’s breasts, which didn’t rattle the older girl.

The team at the Adolescent Breast Center even put Kate’s father at ease discussing what can be a difficult topic for dads, Susan says. Labow took an interest in Kate’s studies and played her favorite country music during treatments, she says.

It was only in Labow’s office that Susan learned how bad the problem was that her daughter had been living with. “Once they hit junior high, kids get quiet about things. I knew it was extensive but I didn’t know how extensive it was,” Susan says.

Now 27, Kate has no regrets about her decision to undergo breast surgery. Kate has evolved from a “quiet child” into an adult who is “very self assured, and not quiet at all,” says her mom.

Kate is engaged to be married next winter. Mom and daughter embarked together recently on another shopping ritual, this time for the perfect wedding dress. Kate wanted a simple lace dress that reflected her understated confidence. She steered clear of draping, ruched or folded bodices that hid her frame. Every dress Kate tried on fit easily and looked beautiful, bringing tears to her mom’s eyes.

*The patient and her mother’s names have been changed to respect their privacy.